Landon B P, Abraham L A, Charles J A
The University of Melbourne Veterinary Clinic and Hospital, Werribee, Victoria 3030, Australia.
Aust Vet J. 2008 May;86(5):169-79; quiz CE1. doi: 10.1111/j.1751-0813.2008.00278.x.
To evaluate the efficacy of cellophane banding of single congenital extrahepatic portosystemic shunts in dogs using transcolonic portal scintigraphy. To investigate the portal circulation of those dogs with elevated postoperative shunt fractions to determine the cause of the persistent shunting. Further, to evaluate whether presenting signs, clinical pathology findings and liver histopathology are predictive of outcome.
Prospective study of 16 dogs presenting with single congenital extrahepatic portosystemic shunts.
Dogs with single extrahepatic portosystemic shunts attenuated by cellophane banding underwent portal scintigraphy and bile acids tolerance testing pre- and post-operatively. Dogs identified with elevated shunt fractions at 10 weeks post-operatively underwent mesenteric portovenography. Qualitative hepatic histopathology from all dogs was reviewed by a veterinary pathologist and assigned a semi-quantitative score to identify any abnormalities that may predict surgical outcome.
At 10 weeks post cellophane banding, 10 of 16 cases (63%) had normal shunt fractions, whilst six dogs (37%) had increased shunt fractions and seven dogs (44%) had increased serum bile acids. Of these dogs, mesenteric portovenography revealed incomplete closure of the shunt in three dogs (18.6%) and multiple acquired shunts in three dogs (18.6%). Liver histopathology findings were similar for all dogs, regardless of outcome.
Cellophane banding is an efficacious method for complete gradual occlusion of single extrahepatic shunts when the shunt vessel is attenuated to < or = 3 mm. Transcolonic portal scintigraphy is a reliable method for assessment of shunt attenuation and, unlike serum bile acids, is not influenced by other causes of liver dysfunction.
使用经结肠门静脉闪烁扫描术评估犬先天性肝外单分流术的玻璃纸包扎疗效。调查术后分流分数升高的犬的门静脉循环，以确定持续分流的原因。此外，评估临床表现、临床病理检查结果和肝脏组织病理学是否可预测预后。
对16只患有先天性肝外单分流术的犬进行前瞻性研究。
对接受玻璃纸包扎使分流减弱的肝外单分流术犬在术前和术后进行门静脉闪烁扫描术和胆汁酸耐量试验。对术后10周分流分数升高的犬进行肠系膜门静脉造影。由一名兽医病理学家对所有犬的定性肝脏组织病理学进行检查，并给予半定量评分，以确定可能预测手术结果的任何异常情况。
玻璃纸包扎术后10周，16例中有10例（63%）分流分数正常，6只犬（37%）分流分数升高，7只犬（44%）血清胆汁酸升高。在这些犬中，肠系膜门静脉造影显示3只犬（18.6%）分流未完全闭合，3只犬（18.6%）出现多处后天性分流。无论结果如何，所有犬的肝脏组织病理学检查结果相似。
当分流血管减弱至≤3mm时，玻璃纸包扎是完全逐渐闭塞肝外单分流的有效方法。经结肠门静脉闪烁扫描术是评估分流减弱的可靠方法，与血清胆汁酸不同，它不受肝功能障碍其他原因的影响。
